Association Between Cardiovascular Risk Factors and Pan-Coronary Plaque Burden, Phenotype, and Vulnerability: A...

Area of Science:

• Cardiology
• Vascular Biology
• Medical Imaging

Background:

• Cardiovascular risk factors (RFs) are crucial for predicting adverse cardiovascular outcomes like acute coronary syndromes (ACS).
• Previous research suggests a link between RFs and plaque vulnerability in ACS patients.

Purpose of the Study:

• To investigate the association between modifiable and non-modifiable RFs and pan-coronary plaque burden.
• To analyze the relationship between RFs and plaque phenotype, specifically features of vulnerability.

Main Methods:

• Optical coherence tomography (OCT) imaging was used in a 3-vessel analysis of 131 patients (36.6% with ACS).
• Modifiable RFs (dyslipidemia, hypertension, diabetes, obesity, smoking) and non-modifiable RFs (age, sex, family history) were recorded.
• Plaque number, phenotype, and vulnerable features (e.g., thin-cap fibroatheromas [TCFAs], lipid-rich plaques [LRPs], cholesterol crystals) were quantified.

Main Results:

• A higher number of RFs correlated with an increased number of plaques and a greater prevalence of vulnerable phenotypes like TCFAs.
• Increasing RFs were associated with more vulnerable features, including thin fibrous caps, LRPs, macrophages, microvessels, and cholesterol crystals.
• Multivariable analysis revealed that only modifiable RF burden independently predicted increased pan-coronary vulnerability, TCFAs, LRPs, and cholesterol crystals.

Conclusions:

• The study demonstrates a direct relationship between the number of cardiovascular RFs and the burden of coronary plaques with high-risk phenotypes and vulnerable features.
• Modifiable RFs emerged as the primary driver of pan-coronary vulnerability, emphasizing their importance in clinical management.